Aveneu Park, Starling, Australia

Living influence on gender identity. Furthermore gender dysphoria

Living in the wrong body – The influence of gender identity and sex on
gender dysphoria

 

Introduction:

 

The
Roman emperor Elagabalus was famous for his religious controversy and for his
sex scandals. According to Cassius Dio the emperor found himself being fond of
being called ‘mistress’ or ‘Queen of Hierocles’ by others and enjoyed wearing
dresses. He desired to have female genitelia and did not hesitate to offer a
great sum of money to any physician who would be able to fulfil his wish1.
Elagabalus may have been an exotic Roman Emperor indeed, but he was by far not
the only one in human history who desired to belong to the opposite sex.

 

The phenomena of
the desire to belong to the opposite sex is called gender dysphoria. The ICD-10
classifies three types of gender dysphoria: 
transsexualism, dual-role
transvestism and gender identity disorder of
childhood.

Gender dysphoria is influenced by
many factors. This paper will concern itself mainly with the influence of
gender identity and sex. It is important that it is clear from the beginning
that the terms gender and sex will be treated distinctly in this paper.  Gender is the identification of a person as being
female or male while sex is the biological component. Sex
determines whether a person has a penis or a vagina, while gender determines
whether the person wants/ identifies with the penis or the vagina2

 

To identify how
gender identity and gender dysphoria come into existence and how they relate to
each other, gender identity will be studied first, therefore the usual
pattern of gender identity development will be examined as well as the unusual
pattern.  The role of the biological sex
on gender identity and gender dysphoria will be explored more closely too, as
well as its influence on gender identity. Furthermore gender dysphoria and its
subcategories will be studied (transsexualism, dual-role transvestism, gender
identity disorder of childhood) according to the classification of ICD-10.

Finally the final question how
gender identity and sex influence gender dysphoria will be discussed before
coming to the final conclusion.

 

The aim of this paper is to clarify
the understanding of gender identity, sex and gender dysphoria as well as their
differences, and most importantly: their influences.

 

Assignment 5b: Main body: provisional draft

 

II. Gender identity

 

2.1. Definition of Gender identity:

As part of our social identity,
gender identity is concerned about the identification (or sometimes
non-identification) of a person with a certain sex, usually the same sex the
person is born with3.
It is however possible that the gender identity of a person differs from the
assigned sex at birth, e.g. a woman identifying as a man or, like the example
given in the introduction, the Roman Emperor Elagabalus identifying as a woman.
What consequences a non-identification of the assigned sex at birth has, will
be discussed more closely in the following sections.

 

2.2. Usual Pattern of development of Gender identity:

In the following we will consider
the usual pattern of development of gender identity in a person and the unusual
pattern which leads to gender dysphoria.

How gender identity comes into
existence in a child (gender typing)4 has been theorized by many
theorists, including Freud, Bandura and Kohlberg. Freud, who developed a
psychoanalytic theory about gender typing, proposed that a child develops his
gender identity through walking through several stages of his psychosexual
development5.
Bandura on the other hand, proposed a social learning-theory in which the child
acquires his knowledge through two concepts: direct tutuition (encouragement of
parents to engage in gender-typical behaviour) and observational learning
(imitation of behaviour of members of the same sex)6.

Kohlberg however proposed a more cognitive
developmental scheme in which he proposed that children acquire gender typing
by walking through three stages: gender identity (correct labelling of persons
to their sex), gender stability (understanding the conception that boys develop
to man and girls develop into being woman) and gender consistency  (knowledge that gender does not change)7.

 

2.3. Unusual pattern of development of Gender identity:

As there are many different theories about the usual pattern of development of gender
identity, there are also several theories about the unusual development of gender identity (Atypical gender
development)8.

Atypical gender development can be attributed
to environmental as well to genetic factors. 
A heightened testosterone level in girls has been found to affect gender
identity, personality and sexual orientation. Girls with a heightened
testosterone level due to congenital adrenal hyperplasia (CAH) are found to be
more aggressive and less emphatic, traits that are more commonly associated to
men9.

 Genetic
contributors to an atypical gender development may be for example due to the
ERß gene, a gene that encodes estrogens. Women who have a higher amount of ERß
are found to be more likely to develop female-to-male transsexualism10

 

III. Gender dysphoria

 

3.1. Definition of Gender dysphoria:

 Gender
dysphoria is defined as: “a conflict between a person’s physical or assigned
gender and the gender with which he/she/they identify”11.
This means that a person who suffers under gender dysphoria suffers under the
conflict of the assigned sex of him/her at birth and his identification of the
opposite sex. The person may feel uncomfortable in his own body and will seek
ways to relief this distress. He hereby may choose different options to relieve
his distress, some individuals may feel a relief when they can switch
temporarily to the opposite sex by cross-dressing, others may only feel
relieved by having a sex-changing operation. How these different kinds of
expression of the internal conflict are expressed, will be more closely
examined in the following sections.

 

3.2. Transsexualism:

The ICD-10 defines transsexualism as the desire
to “live and be accepted as a member of the opposite sex, usually accompanied
by the wish to make one’s body as congruent as possible with one’s preferred
sex through surgery and hormonal treatment”. It has to be noted however that
this, on the spectrum of gender dysphoria, belongs to the extreme end12.
Not everyone who has gender dysphoria, has the desire to have a sex-change
surgery, like people who are diagnosed with Dual-role Transvestism13.
Further criteria to be diagnosed with transsexualism is the presence of the
wish to reassign your gender for at least two years and the condition that the
wish to belong to the opposite sex is not symptom of another mental disorder,
like schizophrenia, where it may be part of the delusion or a chromosome
abnormality (like in hermaphroditism).

 

3.3. Dual-role Transvestism:

People who are diagnosed with Dual-role Transvestism
are also included in the spectrum of gender dysphoria. According to the ICD-10
to be diagnosed with Dual-role transvestism one has to have the desire to dress
temporarily as the opposite sex without feeling sexually aroused by the
cross-dressing14.

 

3.4. Gender identity disorder of childhood:

In the above sections disorders that appear
mostly in adulthood or adolescence were described. Gender dysphoria can however
appear in childhood as well. The ICD-10 has set up several conditions to be
diagnosed as such, as, divided between female and male. For girls, there has to
be a displayed distress of being a girl and a desire/ insistence of being a
boy; she has either to show a rejection of traditional feminine clothes and a
inclination to wear male clothes or an aversion against her female anatomic
structure (or both), her aversion can be displayed as the following: the claim
that she has or will grow a penis; the rejection to urinate in a sitting
position; the belief that she will grow no breast and will not menstruate.

These criteria, in order to be fulfilled, have
to be apparent before the girl reaches puberty and have to be displayed for six
months15.

For boys the first three criteria are the same,
but then in reverse. His rejection of his male anatomic parts are displayed by:
his belief that he will grow up to be woman; that his male genitals are disgusting
or will disappear; the belief that it would be better to have no male genitals.
Here as well, the boy should not have reached puberty yet and the symptoms have
to be apparent for at least six months16.

 

Assignment 5c: Discussion:
Provisional Draft

 

IV: Discussion: How does gender
identity and gender dysphoria come into existence and how do they relate to
each other?:

 

As discussed above, there are several theories
to how gender identity and how gender dysphoria come into existence.

 While
environmental and genetic factors are considered to be essential for the
development of gender dysphoria, social and psychological models are suspected
to be the reason for the development of gender identity.

Although their coming to existence may be due
to significantly different reasons, it can be at least reasoned that gender
identity has a significant influence on gender dysphoria.

As discussed above, gender dysphoria is defined
as “a conflict between a person’s physical or assigned gender and the gender
with which he/she/they identify”17.

As the definition makes clear, gender dysphoria
comes into existence due to his/her gender identity being in conflict with the
assigned sex at birth. This means that the influence of gender identity
consists of the conflict it causes in a person between his sex and the gender
he identifies with.

 

When referring back to the original research
question of this paper, how gender identity and gender dysphoria come into
existence and how these two relate to each other, only the part about the
influence of gender identity on gender dysphoria, can be answered.

The part how gender identity and gender
dysphoria come into existence, can not be answered satisfactorily since there
are to many different theories and not sufficient research (in case of how
gender dysphoria comes into existence) to give a complete and correct answer.

 

My recommendation therefore would be to invest
more time in the research of the development of gender dysphoria and also in
gender identity.

 

 

 

 

 

 

 

 

Assignment 5d: Citing and References

V. Reference List:

–       
American Psychological Association. (2016). What is Gender Dysphoria?. Retrieved
December 01, 2017, from: https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

–       
Cohen-Kettenis, P.T., & Gooren, L.J.G. (1999).
Transsexualism: A review of etiology, diagnosis and treatment. Journal of
Psychosomatic Research, 46, 315-333. Doi: https://doi.org/10.1016/S0022-3999(98)00085-3.

–       
Dio, C. Roman
History. Retrieved from: http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Cassius_Dio/80*.html#79-16

–       
Fernández, R., Esteva, I., Gómez-Gil, E., Rumbo T., Cruz
Almarez, M., Roda, E., … Pásaro, E. (2014). The (CA)n Polymorphism of ERß is
associated with FtM Transsexualism. The Journal of Sexual Medicine, 11,
720-728. Doi:  https://doi.org/10.1111/jsm.12398.

–       
Frable, D. (1997). Gender, Racial, Ethnic, Sexual and
Class identities. Annual Review of
Psychology, 48, 139-162. Doi: https://doi.org/10.1111/jsm.12398.

–       
Ghosh, S. (March 16, 2015). Retrieved from: https://emedicine.medscape.com/article/917990-overview

–       
Hines, M. (2011). Gender Development and the Human
Brain. Annual Review of Neuroscience, 34, 69-88. Doi: https://doi.org/10.1146/annurev-neuro-061010-113654.

–       
Mullahy, P. (1948). Oedipus: myth and complex: a review of psychoanalytic theory. New York, NY:
Hermitage Press.

–       
Schaffer, D. (2009). Social and Personality Development. Belmont, Canada: Wadsworth.

–       
World Health Organization. (2016). The ICD-10 Classification of Mental and
Behavioural Disorders. Retrieved from: http://www.who.int/classifications/icd/en/GRNBOOK.pdf.  

1
Ghosh, S. (March 16, 2015). Retrieved from: https://emedicine.medscape.com/article/917990-overview

2 Dio,
C. Roman History. Retrieved from: http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Cassius_Dio/80*.html#79-16

3American
Psychological Association. (2016). What
is Gender Dysphoria?. Retrieved December 01, 2017, from: https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.

4 Schaffer,
D. (2009). Social and Personality
Development. Belmont, Canada: Wadsworth.

5 Mullahy,
P. (1948). Oedipus: myth and complex: a
review of psychoanalytic theory. New York, NY: Hermitage Press.

6 Schaffer,
D. (2009). Social and Personality
Development. Belmont, Canada: Wadsworth.

7 Frable,
D. (1997). Gender, Racial, Ethnic, Sexual and Class identities. Annual Review of Psychology, 48,
139-162. Doi: https://doi.org/10.1111/jsm.12398.

8 American
Psychological Association. (2016). What
is Gender Dysphoria?. Retrieved December 01, 2017, from: https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.

9 Hines,
M. (2011). Gender Development and the Human Brain. Annual Review of
Neuroscience, 34, 69-88. Doi: https://doi.org/10.1146/annurev-neuro-061010-113654.

10 Fernández,
R., Esteva, I., Gómez-Gil, E., Rumbo T., Cruz Almarez, M., Roda, E., … Pásaro,
E. (2014). The (CA)n Polymorphism of ERß is associated with FtM Transsexualism.
The Journal of Sexual Medicine, 11, 720-728. Doi:  https://doi.org/10.1111/jsm.12398.

11 American
Psychological Association. (2016). What
is Gender Dysphoria?. Retrieved December 01, 2017, from: https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.

12Cohen-Kettenis,
P.T., & Gooren, L.J.G. (1999). Transsexualism: A review of etiology,
diagnosis and treatment. Journal of Psychosomatic Research, 46, 315-333. Doi: https://doi.org/10.1016/S0022-3999(98)00085-3.
 

13 American
Psychological Association. (2016). What
is Gender Dysphoria?. Retrieved December 01, 2017, from: https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.

14 World
Health Organization. (2016). The ICD-10
Classification of Mental and Behavioural Disorders. Retrieved from: http://www.who.int/classifications/icd/en/GRNBOOK.pdf.

15 World
Health Organization. (2016). The ICD-10
Classification of Mental and Behavioural Disorders. Retrieved from: http://www.who.int/classifications/icd/en/GRNBOOK.pdf.

16World
Health Organization. (2016). The ICD-10
Classification of Mental and Behavioural Disorders. Retrieved from: http://www.who.int/classifications/icd/en/GRNBOOK.pdf.  

17 American
Psychological Association. (2016). What
is Gender Dysphoria?. Retrieved December 01, 2017, from: https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.